Your best competitive advantage? A solid social work department

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Eleanor Feldman Barbera, Ph.D.
Eleanor Feldman Barbera, Ph.D.

I have great respect for those who attend to the often complicated physical needs of our long-term care residents, but if your facility doesn't have a solid social service department, it isn't as good as it could be. Yes, the medical care is vital, but the social service department addresses many of the issues essential to resident satisfaction.

Market researcher Margaret A. Wylde, PhD, notes that the three most important elements of satisfaction with a long-term care community are the friendliness of staff, the degree to which residents feel the community is their home, and the opportunity they have to stay connected with the rest of the world. 

In her 2010 McKnight's Online Expo talk, she stated that it's very satisfied residents who refer others to their communities. 

Consider the multitude of tasks the average social worker performs:

·      Helps the resident settle into the facility

·      Handles roommates conflicts

·      Facilitates room changes

·      Assists with the purchase of new clothing

·      Locates or arranges for reimbursement of lost clothing

·      Facilitates the signing of financial forms

·      Explains and establishes advance directives

A social worker also will:

·      Liaison with families as the main point person on the team

·      Provide additional support to families in distress

·      Put discharges in place, an often complex procedure involving multiple departments, agencies and family members

·      Apply for wheelchair accessible transportation services

·      Arrange for telephone installation

·      Set up newspaper and/or magazine subscriptions

·      Facilitate resident contact with family members through phone calls and home passes

The first half of the list contains items that help residents feel less anxious and more at home within the facility while the second half focuses on maintaining contact with family members and the community.

This extensive list of tasks is just a partial inventory of social work duties! All of these responsibilities must be documented, leading to an overload of paperwork that leaves little time for other mental health functions of the social work department, such as

·      Counseling distressed residents

·      Providing psycho-education regarding illness

·      Establishing consistent enough contact to notice mental status changes

·      Referring residents for mental health services such as psychology and psychiatry

·      Attending to team functioning

The above clinical activities are likely what drew your social workers to their jobs. When they're preoccupied with discharges, admissions and paperwork, and can't attend to these functions, chances are they aren't going to be as happy and friendly as they could be. 

They also won't stick around long, creating a revolving door of social workers that wreaks havoc on the rest of the team. 

In addition, while consulting psychologists and psychiatrists provide mental health services to residents who have been referred for treatment, the social workers are the main mental health providers on the team. If they're too busy to handle the clinical tasks or haven't been trained to do so, no one is managing the mental health issues of the residents.

No one is paying attention to the team dynamics that impact the level of friendliness of the staff toward each other, and toward the residents and their visitors.  The system is relying on the psychological-mindedness of individual staff members rather than establishing a point person empowered to address these important issues.

The Fix

Here's how you can make things better at your place:

·      Hire an experienced masters-level social worker to head your department

·      Include as many masters-level social work staff as your budget will allow

·      Hire enough social workers to do the job, not just the paperwork

·      Provide ongoing training and supervision, especially for less experienced and less educated staff members

·      Train all workers not only in the basic tasks and paperwork, but also to be your mental health point person and your eyes and ears in team functioning

·      Maintain consistent staffing so they know their residents, families, and teams

·      Empower your social workers (and your nurses and other staff) to address the tone of the community

·      Encourage them to bring issues such as staff conflicts or a lack of a warm, friendly tone to the in-service coordinator who can provide staff training

·      Provide clerical support to relieve the social workers of some of the paperwork demands so they can focus their attention on the residents, families, and teams

The amazing good

A well-functioning social work department is your facility's best calling card. Your social workers will offer a pleasant, friendly face to the multitude of residents, families and agencies they deal with on a daily basis.

They'll put out fires, and prevent fires from occurring through recognizing emotional distress in their residents, families and staff members. They'll refer people for mental health treatment, conduct family education sessions, and notify the nursing supervisor and in-service coordinator of team issues that need to be addressed. They'll be instrumental in creating a home-like, friendly environment that increases resident satisfaction and leads to referrals to your community.

With proper support and recognition, they'll love their jobs and stay with you for years, because being a long-term care social worker is an amazing way to do good in the world.

Eleanor Feldman Barbera, PhD, the author of The Savvy Resident's Guide, is an accomplished speaker and consultant on psychological issues in long-term care. A long-time contributor to McKnight's publications, this blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.


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